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Transcript
Communicable Disease - current
knowledge, impact and issues for new
migrant communities
Dr. Mamoona Tahir, Consultant in Communicable Diseases
Public Health England
Overview
•
Who are the migrants?
•
Are migrants more likely to experience ill health?
•
Why are the migrants at increased risk?
•
More likely to experience poor outcomes?
•
What can be done to improve migrants health
Who are migrants?
•
A person who moves from one place to another in order to find work or
better living conditions
(Oxford dictionary definition)
•
Foreign born, foreign national or people who have moved to the UK for
more than one year
(International Migration Organisation & Oxford Migration Observatory)
Countries of last residence of UK migrants
Source: Long-Term International Migration (LTIM), Office for National Statistics
Reasons for migrating to the UK: 2001-2010
Source: Long-Term International Migration (LTIM), Office for National Statistics
Migration pattern closely linked to disease
epidemiology
Most non-UK born people do not have infectious
diseases …
UK born population
Non-UK born
population
Burden of
infectious
disease
... but much of the burden of infectious
diseases falls on the non-UK born population
The majority of cases of…
TB
(73% of cases reported in the UK in 2010)
HIV
(almost 60% of newly diagnosed cases reported in the UK in 2010)
Malaria
(77% of cases reported in the UK between 2005 and 2010)
Enteric fever
(63% of cases reported in England, Wales and Northern Ireland between
2007 and 2010)
…do occur in people who were born abroad
Why are migrants at increased risk?
•
Higher disease burden
•
Poor living conditions
•
Experiences during migration
•
Socioeconomic conditions in the UK
•
Factors relating to ethnicity and cultural practices
•
Awareness and health seeking behaviour
•
Frequent travel to country of birth
Missed opportunities for health intervention
in at risk migrant groups?
• TB; no co-ordinated UK system currently for detection of
infection/cases
• HIV; unrecognised infection and late diagnoses
• Hep B and C; unrecognised infection and late diagnoses
• Chagas; unrecognised
• Parasitic worms; unrecognised
• Enteric fever; VFR travellers to ISC; no immunisation
• Malaria; VFR travellers to west Africa; no chemoprophylaxis
• Non-infectious health conditions; diabetes, IHD, genetic disorders,
maternity care, FGM, nutritional, chemical exposures, mental health,
etc.
Figure : Tuberculosis case reports and rates by region*,
England, 2012
4,000
3,500
50
41.9
Number of cases
45
Rate (per100,000) and 95% CI
40
3,000
Number of cases
2,500
30
2,000
25
19.4
20
1,500
1,000
11.3
11.5
9.3
15
10.8
7.8
5.8
500
0
Region
* HPA region
CI – 95% confidence intervals
Source: Enhanced Tuberculosis Surveillance (ETS), Office for National Statistics (ONS)
Data as at July 2013
Prepared by: TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England
Tuberculosis in the UK: 2013 report
10
5
0
11
6.4
Rate (per 100, 000)
35
Fig: Tuberculosis case reports by place of birth and
country, UK, 2012
Non UK-born
UK-born
100%
90%
2,020
Percentage of cases
80%
39
142
56
48
185
73
70%
60%
50%
40%
5,819
30%
20%
10%
0%
Country (% where place of birth known)
Source: Enhanced Tuberculosis Surveillance (ETS), Enhanced Surveillance of Mycobacterial Infections (ESMI)
Data as at July 2013
Prepared by: TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England
12
Tuberculosis in the UK: 2013 report
Country of origin of TB cases
Tuberculosis rates by Upper Tier Local Authority,
West Midlands, 2013*
*Rates were calculated using 2012 mid-year population estimates from ONS
Data sources: Enhanced Tuberculosis Surveillance (ETS) downloaded on 10th March 2014.
16
Prepared by: Field Epidemiology Service (Birmingham), Public Health England
Treatment outcome
Human Immune deficiency Virus
•
•
•
•
In 2010 6,658 individuals were
diagnosed with HIV in UK
65% of people diagnosed between
2001 and 2010 in whom the country
of birth was recorded, were born
abroad
Among these 80% of infection were
acquired heterosexually
Africa was reported as the region of
birth for the majority (87%) of
heterosexual non-UK born new
diagnoses.
Forty-eight per cent of African bornheterosexuals reported South
Eastern Africa as their region of birth
200
180
Rate per 100,000 population
•
New HIV diagnoses per 100,000 population by ethnicity,
West Midlands residents, 2012
187
160
140
120
100
80
60
40
20
3
19
5
4
0
Asian
Black African
Black
Other/Mixed
Caribbean/
Other/
Unspecified
Ethnicity
White
HIV
Percentage of new HIV diagnoses that were diagnosed late by world region of birth, West Midlands
residents, 2012
80%
70%
72%
Percent diagnosd late
60%
63%
60%
50%
52%
50%
40%
43%
30%
33%
20%
10%
0%
United Kingdom
Outside UK
(total)
Africa
Asia
Latin American
and the
Caribbean
World region of birth
Other Europe
Unknown
Hepatitis B
These sentinel surveillance data exclude dried blood spot, oral fluid, reference testing, and testing from hospitals referring all samples. Data are
de-duplicated subject to availability of date of birth, soundex and first initial. All data are provisional.
A combination of self-reported ethnicity, and OnoMap and NamPehchan name analyses software were used to classify individuals according to
broad ethnic group.
Source: Public Health England, LabBase cleaned dataset.
Hepatitis C
• In 2012, there were 13
laboratory reports of hepatitis
C per 100,000 population for
residents of the West
Midlands, compared to 20 for
residents of England.
• Since 2010 the gap between
rates in the West Midlands
and rates in England has been
widening.
Source: Public Health England, Labbase
Data are summarised by region of residence, not region of laboratory. Data are assigned to region by patient postcode where
present; if patient postcode is unknown, data are assigned to region of registered GP practice; where both patient postcode and
registered GP practice are unknown data are assigned to region of laboratory.
Includes individuals with a positive test for hepatitis C antibody (a marker of past infection) and/or detection of hepatitis C RNA (a
marker of persistent infection). Due to the variability in the quality of laboratory reports, we are unable to estimate the actual
proportion of cases with evidence of past infection or persistent infection.
21
Epidemiology of hepatitis B and C in Birmingham and Solihull
Hepatitis C
• At the West Midlands sentinel
laboratory, Asians had the
highest positivity rate.
• Lower positivity rates for those
of black and other/mixed
ethnicity are based on a
relatively small number of
tests.
• Data is for all tests processed
by the West Midlands sentinel
laboratory, irrespective of
residence.
Source: Public Health England, Sentinel Surveillance of hepatitis.
* Excludes dried blood spot, oral fluid, reference testing, and testing from hospitals referring all samples. Data are de-duplicated
subject to availability of date of birth, soundex and first initial. Excludes individuals aged less than one year, in whom positive
tests may reflect the presence of passively-acquired maternal antibody rather than true infection. All data are provisional.
§ A combination of self-reported ethnicity, and OnoMap and NamPehchan name analyses software were used to classify
individuals according to broad ethnic group.
22
Epidemiology of hepatitis B and C in Birmingham and Solihull
• Reporting of patient residence
information is incomplete;
From 2008 to 2012, around
half of laboratory reports
included the patient’s
postcode; therefore rates
shown on the map are likely
to be underestimates.
• Where patient residence
information was reported, the
wards with the highest rates
per 100,000 population were
Bordesley Green, Washwood
Heath and Sparkbrook.
24
Epidemiology of hepatitis B and C in Birmingham and Solihull
Recommendations
• Migrants and VFR /Travellers awareness of the risk of catching the disease,
mode of acquisition and how they can protect themselves.
• Increased awareness among general public
• Primary care practitioners play a vital role in early identification of infectious
diseases
• Early identification of risk and diagnosis of infection can improve health
outcome
Recommendations
•
Practitioners are encouraged to consider their patients’ country of birth
when evaluating their risk exposures and to guide their differential diagnosis
of presenting symptoms
•
Many UK practitioners may be unfamiliar with the clinical presentation of
some infectious diseases that are rarely diagnosed in the UK
•
need for non-UK born communities to have access to culturally competent
and language supported services
•
importance of considering health needs relevant to an individual’s country of
birth
Summary
•
Migrants experience a high burden of infectious diseases in West Midlands
•
Reflective of incidence in the country of origin.
•
The late diagnosis of HIV suggests the needs of the migrant are not being
met
•
GPs could play a role in screening migrant for HIV, Hepatitis and TB for
migrants from high incidence countries
•
Practitioners awareness of needs of the migrants is important